ATCH_1_-_BLANK_PRICE_LIST_-_AMDT_0001.doc

REQUEST FOR QUOTATION (RFQ) HTC711-17-Q-R002

ATTACHMENT 1

PRICE LIST

0001 AIR TRANSPORTATION. Air Ambulance Service from OCONUS to the CONUS and within CONUS. Special requirements may be offered on a case-by-case basis. In the future, service areas may be expanded to include within OCONUS Geographic Combatant Commands (GCCs). The AORs are defined at the following website: http://www.defense.gov/ucc/. Unit price includes all costs associated with each Great Circle Statute Mile (GCSM) flown, excluding prices for patient care provided by medical personnel below. The unit price shall include fuel costs at the pegged rate stated in “Economic Price Adjustment Based on Actual Cost of Fuel – Airlift” in Attachment 4.

NOTE 1: The Government’s obligation for payment of the positioning leg miles shall be for actual miles flown, but shall not exceed the mileage between the contractor’s primary operations location and the patient’s embarkation point. For “Round Trip” missions, the Government’s obligation for payment of depositioning leg miles shall be for actual miles flown, not exceeding the mileage between the patient’s debarkation point and the contractor’s primary operations location. Depositioning leg miles will not be paid for “Point-to-Point” missions. However, if base or airport regulations do not allow the aircraft to remain after debarkation of the patient, depositioning costs to the closest civilian airport that will accept your aircraft will be paid.

NOTE 2: The total miles flown is provided by the contractor following the mission but shall not deviate more than 5% from the miles calculated from the Great Circle Mapper website (http://gc.kls2.com/)

Round-Trip Point-to-Point

Jet Aircraft

$_________ per GCSM

$_________ per GCSM

Turbo-Prop

$_________ per GCSM

Rotary-Wing

$_________ per GCSM

0002 MEDICAL PERSONNEL.

Level One (ACM-1) Crew Member

$_________ per HOUR

Level Two (ACM-2) Crew Member

Level Three (ACM-3) Crew Member

Level Four (ACM-4) Crew Member

Respiratory Therapist

Unit prices for the medical personnel shall be paid for all hours flown in support of an awarded mission, beginning when the positioning leg miles start, and concluding immediately when depositioning leg ends.

0003 REIMBURSABLE EXPENSES. Reimbursable Expenses include (if applicable) Cancellation Costs, Landing/ Parking/Airport Fees, International Fees, Federal Transportation Tax, and Food and Lodging if required to remain overnight. Additional mission related Reimbursable Expenses may be added to this price list by an attachment. All invoices for reimbursable expenses must be accompanied by paid receipts.

0004 FUEL EPA REIMBURSABLE. Fuel adjustment IAW “Economic Price Adjustment Based on Actual Cost of Fuel – Airlift”. NOTE: The burn rates shall be consistent with the rates identified in the BPA. Separate calculations for different burn rates are required for every aircraft used.

SIGNATURE DATE

TYPED NAME AND TITLE

COMPANY NAME AND ADDRESS

PHONE

E-MAIL ADDRESS

A